MALIGNANT NEOPLASM OF THE COLON

Instrument No.58 of 2002

Revocation of

Statements of Principles

concerning

MALIGNANT NEOPLASM OF THE COLON

and

MALIGNANT NEOPLASM OF THE RECTUM

and Determination

of

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE COLORECTUM

ICD-10-AM CODES: C18, C19, C20

Veterans' Entitlements Act 1986

1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the Act):

(a) revokes Instrument No.23 of 1996, as amended by Instrument No.5 of 1998, concerning malignant neoplasm of the colon and Instrument No.25 of 1996, as amended by Instrument No.3 of 1998, concerning malignant neoplasm of the rectum; and

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(b) determines in their place the following Statement of Principles.

Kind of injury, disease or death 2. (a) This Statement of Principles is about malignant neoplasm of the

colorectum and death from malignant neoplasm of the colorectum.

(b) For the purposes of this Statement of Principles, "malignant neoplasm of the colorectum" means a primary malignant neoplasm arising from the epithelial cells of the colorectum, which extends from the caecum, including the ileocaecal junction to the junction with the anal canal. This definition of malignant neoplasm of the colorectum excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin's lymphoma and Hodgkin's disease. Malignant neoplasm of the colorectum attracts ICD-10AM code C18, C19 or C20.

Basis for determining the factors 3. The Repatriation Medical Authority is of the view that there is sound

medical-scientific evidence that indicates that malignant neoplasm of the colorectum and death from malignant neoplasm of the colorectum can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.

Factors that must be related to service 4. Subject to clause 6, at least one of the factors set out in clause 5 must be

related to any relevant service rendered by the person.

Factors 5. The factors that must as a minimum exist before it can be said that a

reasonable hypothesis has been raised connecting malignant neoplasm of the colorectum or death from malignant neoplasm of the colorectum with the circumstances of a person's relevant service are:

(a) suffering from a colorectal adenoma before the clinical onset of malignant neoplasm of the colorectum; or

(b) smoking at least 15 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of malignant neoplasm of the colorectum, and

(i) smoking commenced at least 20 years before the clinical onset of malignant neoplasm of the colorectum, and

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(ii) where smoking has ceased, the clinical onset has occurred within 30 years of cessation; or

(c) drinking at least 250 kilograms of alcohol within a 25 year period within the 40 years immediately before the clinical onset of malignant neoplasm of the colorectum; or

(d) having an altered dietary pattern resulting in an increase of at least 100 grams in average daily total consumption of unprocessed beef, veal, pork, lamb or mutton for at least 10 years, where the increased consumption of unprocessed beef, veal, pork, lamb or mutton occurred at least 20 years before the clinical onset of malignant neoplasm of the colorectum; or

(e) having an altered dietary pattern resulting in an increase of at least 25 grams in average daily total consumption of processed meat product for at least 10 years, where the increased consumption of processed meat product occurred at least 20 years before the clinical onset of malignant neoplasm of the colorectum; or

(f) suffering from ulcerative colitis for at least five years before the clinical onset of malignant neoplasm of the colorectum; or

(g) suffering from Crohn's disease of the colorectum for at least five years before the clinical onset of malignant neoplasm of the colorectum; or

(h) suffering from familial adenomatous polyposis before the clinical onset of malignant neoplasm of the colorectum; or

(i) undergoing a course of therapeutic radiation involving the abdominal or pelvic region 10 years or more before the clinical onset of malignant neoplasm of the colorectum; or

(j) an inability to undertake more than a mildly strenuous level of physical activity for at least 10 years within the 30 years before the clinical onset of malignant neoplasm of the colorectum; or

(k) being obese for at least 15 years before the clinical onset of malignant neoplasm of the colorectum; or

(l) for malignant neoplasm of the colon only, inhaling respirable asbestos fibres in an enclosed space for a cumulative period of at least 2000 hours:

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(i) at the time material containing asbestos fibres was being applied, removed, dislodged, cut or drilled, and

(ii) the first inhalation of asbestos fibres commenced at least 10 years

before the clinical onset of malignant neoplasm of the colorectum; or

(m) inability to obtain appropriate clinical management for malignant neoplasm of the colorectum.

Factors that apply only to material contribution or aggravation 6. Paragraph 5(m) applies only to material contribution to, or aggravation

of, malignant neoplasm of the colorectum where the person's malignant neoplasm of the colorectum was suffered or contracted before or during (but not arising out of) the person's relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.

Inclusion of Statements of Principles 7. In this Statement of Principles if a relevant factor applies and that factor

includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.

Other definitions 8. For the purposes of this Statement of Principles:

"a course of therapeutic radiation" means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;

"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;

"an enclosed space" means a substantially enclosed area, for example, the interior of a building, ship or aircraft, a covered workshop or factory;

"an inability to undertake more than a mildly strenuous level of physical activity" means the presence of an incapacity which prevents any physical activity greater than 3 METS, where a "MET" is a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate. (A MET approximates to the energy

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required to rest quietly in bed. A 70 kg man would use about 3 METS when walking at 4 km per hour.);

"being obese" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater. The BMI = W/H2 and where: W is the person's weight in kilograms and H is the person's height in metres;

"death from malignant neoplasm of the colorectum" in relation to a person includes death from a terminal event or condition that was contributed to by the person's malignant neoplasm of the colorectum;

"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Third Edition, effective date of 1 July 2002, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 413 9. Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;

"malignant neoplasm of the colon" means a primary malignant neoplasm arising from the epithelial cells of the colon, which extends from the caecum, including the ileocaecal junction, to the sigmoid colon, but excludes malignant neoplasm of rectosigmoid junction. This definition of malignant neoplasm of the colon excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin's lymphoma and Hodgkin's disease;

"pack years of cigarettes or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack year of tailor made cigarettes equates to 7 300 cigarettes, or 7.3kg of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;

"processed meat product" means preserved or cured meats, including ham, frankfurters, salami and bacon;

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